title: Introduction of a new incentive and target-based contract for family physicians in the UK: good for older patients with diabetes but less good for women?
abstract: OBJECTIVE
  To determine whether the recording of diabetes-related health indicators has increased and differences diminished between age, gender and deprivation groups, following the introduction of the new General Medical Services contract (nGMS), an incentive- and target-based contract for UK family physicians.
  
  
  METHODS
  A serial cross-sectional study set in 310 primary care practices in Scotland serving a population of 1.5 million registered patients, focussing on diabetic patients. Data were taken immediately before the introduction of the nGMS and after it had been in place for 1 year.
  
  
  RESULTS
  One year after the introduction of the nGMS contract, there was a 54.2% relative increase in the number of patients electronically recorded as having diabetes. In addition, measurement of the quality indicators glycated haemoglobin (HbA(1c)), blood pressure, serum creatinine and cholesterol significantly increased (P < 0.05). Women were less likely than men to have HbA(1c)[odds ratio (OR) 0.85, 95% confidence intervals (CI) 0.80-0.91], serum creatinine (OR 0.90, 95% CI 0.84-0.96) and cholesterol recorded (OR 0.83, 95% CI 0.77-0.90) or achieve HbA(1c) (<or= 10.0%; OR 0.87, 95% CI 0.82-0.91) and cholesterol targets (<or= 5.0 mmol/l; OR 0.83, 95%CI 0.77-0.90).
  
  
  CONCLUSIONS
  The introduction of the nGMS contract was associated with a rise in the recording of patients with diabetes and the recording of diabetes-related quality indicators. However, women have not benefited equally from the nGMS contract. Strategies are needed to further improve the ascertainment of quality measures and care for women with diabetes, to lessen the potential burden of morbidity amongst female patients in the community.
authors.affiliation: Department of General Practice and Primary Care, University of Aberdeen, Aberdeen, UK.
authors.forename: M P
authors.initials: MP
authors.lastname: McGovern
authors.forename: D J
authors.initials: DJ
authors.lastname: Williams
authors.forename: P C
authors.initials: PC
authors.lastname: Hannaford
authors.forename: M W
authors.initials: MW
authors.lastname: Taylor
authors.forename: K E
authors.initials: KE
authors.lastname: Lefevre
authors.forename: M A
authors.initials: MA
authors.lastname: Boroujerdi
authors.forename: C R
authors.initials: CR
authors.lastname: Simpson
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000628:therapy; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000191:economics* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics* / Q000592:standards; D010816:Physician Incentive Plans / Q000191:economics*; D010818:Practice Patterns, Physicians' / Q000191:economics* / Q000592:standards; D011785:Quality Assurance, Health Care / Q000191:economics* / Q000592:standards; D012606:Scotland; D012737:Sex Factors; D012959:Socioeconomic Factors; D006113:United Kingdom; D055815:Young Adult